Human immunodeficiency virus (HIV) treatment may be improved in incarcerated individuals with interdisciplinary academic medical care delivered via telemedicine, according to the results of a study presented at the 10th IAS (International AIDS Society) Conference on HIV Science, held July 21to 24, in Mexico City, Mexico.
The Pennsylvania Department of Corrections (PA DOC) operates 24 state correctional institutions across the state. Within PA DOC, the prevalence of HIV is approximately 1.3% (650 cases per 50,000 people) at any given time. For delivery of HIV care, there have been previous collaborations between academic medical centers (AMCs) and state correctional programs that have demonstrated increased virologic suppression, increased CD4 T-lymphocyte counts, and reduced AIDS-related mortality.
Before 2015, the PA DOC used an in-house infectious diseases team for HIV care provision. However, in 2015, the PA DOC contracted with a large academic medical center for HIV medical management to be delivered by an interdisciplinary telemedicine team that consisted of an infectious diseases physician, an experienced nurse practitioner, and an infectious diseases clinical pharmacist as a result of a preferred governmental medication pricing program. Therefore, this retrospective review measured the effect of academic medical center involvement on overall HIV-1 suppression and other clinical markers.
A total of 227 patients with HIV and at least 1 visit in both the pre- and post-collaboration periods without release were included in the study. The pre-collaboration period was July 1, 2014 to June 30, 2015 and the post-collaboration period was July 1, 2015 to June 30, 2016. The primary objective was to compare rates of HIV viral suppression before and after the medical center collaboration, and the secondary objective was to compare HIV and antiretroviral specific characteristics before and after the collaboration. For pill burden, regimen class categorization, regimen frequency, mode of medication delivery (directly observed therapy or medications kept-on-person), HIV-1 RNA levels, and CD4 T-lymphocyte counts paired-data analyses were conducted.
Patient characteristics included mean age 46 years, 97% male, 71% black, 20% had HIV/hepatitis C virus co-infection, and 2% had HIV/hepatitis B virus co-infection. Results showed that CD4 T-lymphocyte counts increased by a mean of 40.1 cells/mm3 (P =.0044) and 90.6% of patients achieved viral suppression. Further, integrase inhibitor use increased by 16.8% (P <.01), while pill burden was reduced by a mean of 1.1 tablets (P <.01). In total, regimens of >4 pills were reduced to a single tablet regimen in 28 patients (12.9%) and regimen frequency was reduced from twice daily to once daily in 21.3% of patients, while the burden of medications kept-on-person increased by 16.1% (P <.01). However, HIV-1 RNA undetectable values (<40 copies/mL) did not differ between the pre- and post-collaboration periods (P =.42).
Overall, the researchers concluded that, “Interdisciplinary academic medical care delivered via telemedicine significantly improved HIV treatment in Pennsylvania incarcerated persons by reducing dosing frequency, decreased pill burden, reducing [directly observed therapy], and increasing CD4 T-Lymphocyte counts without affecting HIV viral suppression.”
Koren D, Lattanzi K, Kaur A, Ramsey F, Tedaldi E, Aldrich J. Improved HIV care in incarcerated individuals via telemedicine in Pennsylvania, United States. Presented at 10th IAS Conference on HIV Science; July 21-24, 2019; Mexico City, MX. Abstract 1377.